Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 Case study 9 week 9.
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- William Paterson University
NUR 6111 Adv Nursing Practice 1
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Case study#9 – Explain you answerA father is in the cardiac intensive care unit holding the hand of his 1-week-old daughter. After discharge,
the mother and father noted that the baby had rapid breathing and was a poor eater. Her color was
mottled with crying and she seemed to sweat when distressed. They took the baby back to the
pediatrician’s office for a weight check and were immediately transported to a local children’s hospital
for cardiac evaluation. The parents believe they are responsible because the mother did not receive
medical care during her pregnancy. This baby is their third child, and they did not have medical insurance
after the father lost his job. Worried about how they are going to pay the medical bills, they met with
financial counselors who are assisting them with information and filing paperwork. Because both parents
are high-school dropouts, neither reads well and they struggle to understand their daughter’s diagnosis
of TOF.
Consisting of four defects, TOF is a congenital cardiac defect that:
1. Requires increasing cardiac workload and the efficiency of heart function.
2. Allows desaturated blood to enter the systemic system without passing through the lungs.
3. Causes shunting from the left side of the heart to the right side with outflow obstruction.
4. Increases pulmonary blood flow, allowing shunting of blood and leading to pulmonary hypertension.
Answer: TOF is a congenital defect that allows desaturated blood to enter the systemic system without
passing through the lungs. As a result of a large VSD that is high in the septum and overriding aorta that
straddles the VSD, desaturated blood is forced across the VSD and out into the aorta. Due to this, it
never reaches the lungs to become oxygenated.
While the father is with the newborn, the mother is in the emergency department with their little boy.
The grandmother watched the boy while his mother and father were at the hospital for his sister’s birth.
The mother of the newborn told her mother that her son has had a fever and red eyes for 4 days. As of
this morning, he refuses to open his mouth to eat or drink. With a faint rash and puffy fingers, the little
boy is irritable and refuses to leave his mother’s lap. The emergency department physician admits the
child with a diagnosis of a viral illness. The next morning, the boy’ hands and feet begin to peel, and the
infectious disease team is consulted. It is determined that he has Kawasaki disease.
The clinical course of this disease progresses in three stages. During the acute phase, the child is treated
with intravenous immunoglobulin and:
1. Aspirin to reduce thrombosis formation that may occur within coronary artery aneurysms
2. Ibuprofen to reduce inflammation of the vascular system
3. Dialysis to remove the toxins resulting from concurrent renal failure
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